During the past decade, controversy has raged about the necessity of renal biopsy for the management of the idiopathic nephrotic syndrome. The debate has centered on whether a precise diagnosis is imperative for steroid treatment or whether such therapy can be given blindly. The above question has not been addressed in the elderly. In this retrospective study 30 patients aged > 60 years, all of whom underwent a renal biopsy for an unexplained nephrotic syndrome, were categorized according to histological findings and clinical evolution of their disease. The spectrum of histology was diverse, the most common renal lesion diagnosed being membranous glomerulopathy (MGN) (23%). At variance with other works is the relatively high incidence of membranoproliferative glomerulonephritis (MPGN) (20%) found by us. Minimal change disease (MCD) and amyloidosis were encountered in 5 (17%) and 4 patients (13%), respectively. Specific therapy (steroids) was administered in 11 patients. No benefit of steroid treatment was shown in patients with either MGN or MPGN. The only lesion which responded to steroids was MCD (3 complete remissions, 1 partial). Only one biopsy was complicated by a clinically significant perirenal hematoma requiring blood transfusion. No surgical intervention was necessary. Our findings tend to favor a positive approach to the performance of a renal biopsy in the management of the nephrotic syndrome in the elderly.